title: Sentinel lymph node biopsy using dye alone method is reliable and accurate even after neo-adjuvant chemotherapy in locally advanced breast cancer--a prospective study.
abstract: BACKGROUND
  Sentinel lymph node biopsy (SLNB) is now considered a standard of care in early breast cancers with N0 axillae; however, its role in locally advanced breast cancer (LABC) after neo-adjuvant chemotherapy (NACT) is still being debated. The present study assessed the feasibility, efficacy and accuracy of sentinel lymph node biopsy (SLNB) using "dye alone" (methylene blue) method in patients with LABC following NACT.
  
  
  METHODS
  Thirty, biopsy proven cases of LABC that had received three cycles of neo-adjuvant chemotherapy (cyclophosphamide, adriamycin, 5-fluorouracil) were subjected to SLNB (using methylene blue dye) followed by complete axillary lymph node dissection (levels I-III). The sentinel node(s) was/were and the axilla were individually assessed histologically. The SLN accuracy parameters were calculated employing standard definitions. The SLN identification rate in the present study was 100%. The sensitivity of SLNB was 86.6% while the accuracy was 93.3%, which were comparable with other studies done using dual lymphatic mapping method. The SLN was found at level I in all cases and no untoward reaction to methylene blue dye was observed.
  
  
  CONCLUSIONS
  This study confirms that SLNB using methylene blue dye as a sole mapping agent is reasonably safe and almost as accurate as dual agent mapping method. It is likely that in the near future, SLNB may become the standard of care and provide a less morbid alternative to routine axillary lymph node dissection even in patients with LABC that have received NACT.
authors.affiliation: Department of Surgery, Vardhman Mahavir Medical College, Safdarjang Hospital, New Delhi, 110023, India. chintamani7@rediffmail.com
authors.lastname: Chintamani
authors.forename: Megha
authors.initials: M
authors.lastname: Tandon
authors.forename: Ashwani
authors.initials: A
authors.lastname: Mishra
authors.forename: Usha
authors.initials: U
authors.lastname: Agarwal
authors.forename: Sunita
authors.initials: S
authors.lastname: Saxena
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001365:Axilla; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000188:drug therapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D004396:Coloring Agents; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008751:Methylene Blue; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D021701:Sentinel Lymph Node Biopsy
chemical_list: D004396:Coloring Agents; D004317:Doxorubicin; D003520:Cyclophosphamide; D008751:Methylene Blue; D005472:Fluorouracil